NQF Safe Practices – Review 2005 Surgical Specialty Hospital Task Force Summary Analysis

1. NQF Safe Practices – Review 2005 Surgical Specialty Hospital Task Force Summary Analysis November 2005 Texas Medical Institute of Technology Texas Medical Institute of Technology • Suggested Potential Exemptions: • SP 2: High Risk Procedures • Not applicable to short stay surgical specialty hospitals; outside their scope of service; they do not perform high risk procedures. • SP 4: Use of Intensivists in the ICU • Not directly applicable to ASCs that perform only outpatient procedures and short stay facilities that have no ICU services. MAY be applicable to larger short stay facilities that have limited ICU services. • SP 15: Prophylactic Use of Beta Blockers • Strong support for continued inclusion for acute care hospitals and specialty surgical hospitals that perform procedures with ASA classifications which warrant the use of beta blockade. For this ASC’s and short stay facilities that only perform procedures with ASA classifications 3 or less this safe practice would not be applicable. There is currently no clear benchmarking data out there for surgical specialty hospitals on this issue. • SP 16: Pressure Ulcer Prevention • On average thepatients treated in surgical specialty facilities are either outpatients or short stay 24-48hr admissions. Pressure Ulcers are rare and nursing staff perform pre-op assessments of pts in pre-op holding areas. Generally pts already compromised and pre-disposed to skin tears due to age and skin fragility are at highest risk; pts with procedures greater then 2 hours in length are at risk but monitored as feasible during surgery. • SP 18: Anti-Coagulation Management • Strong support for the safe practice; however limited use in ASC and short stay surgical specialty hospitals. ? Economic feasibility for these facilities to establish a Anti-Coag Clinic; but can work closely with primary MDs and surgeons for appropriate follow-up with patients and MD management in their offices. • SP 20: Prevention of Central Line Infections • The 24-48hr short stay nature of the surgical specialty hospital and ASC procedures makes placement of central lines extremely rare. On those rare occasions when they are placed, its generally during the surgical case and consistently discontinued in the post op recovery area. Central Lines are not in place long enough to develop an infection. • SP 23: Evaluate for Risk of Malnutrition • Strong support for the safe practice in acute care hospitals with longer LOS. Patients in short stay specialty hospitals are admitted for such short periods of time or are outpatient…they are not there long enough for effective nutritional intervention. Pts which are determined to be truly malnourished may be referred back to their primary MD for further follow-up • .

2. NQF Safe Practices – Review 2005 Surgical Specialty Hospital Task Force Summary Analysis November 2005 Texas Medical Institute of Technology Texas Medical Institute of Technology • Discussion Results: • SP 3: Clinical Nurse Staffing • . Discussion clarified the term “explicit process” does not mean specific ratio; instead a process to determine appropriate targeted staffing levels for the various clinical areas providing care to patients; whether that is pre – intra – or post-op settings or on clinical units. SP applicable as is. • SP 11: Advanced Directives • Concernsexpressed regarding DNR orders which are most often suspended during surgical interventions. Discussion centered around the focus of the SP which is looking for a process which documents the pts expressed wishes regarding end of life decisions. SP applicable. • SP 17: Evaluate for Risk of DVT • Discussion centered around short term stay of patients and extremely low incidence of DVT development. Review of the SP indicated focus on assessing patient for the risk of DVT. Agreement determined that a pre-op screening or evaluation for the risk of DVT could be implemented if it was not already in place so appropriate measures could be implemented to reduce the risk of developing a DVT. SP applicable. • SP 19: Evaluate for Risk of Aspiration • Discussion centered around rare incidents of ventilator use except intra-operatively; patients rarely stay on a ventilator beyond recovery room. Discussion focused on risk of aspiration and pre-op assessment of patients. Risk of aspiration occurs most frequently when patient is poor historian or non-compliant regarding PO intake the day of surgery leading to potential for intra-operative aspiration if the pt. vomits. SP applicable with primary emphasis on risk of aspiration. Suggest separating VAP care from risk of aspiration. • SP 24: Use of Pneumatic Tourniquets • ASCs and Short Stay hospitals still use pneumatic tourniquets….protocols for management in place. SP applicable. • SP 26: Vaccination of Healthcare Workers • Discussion centered around concerns of making an SP requirement related to vaccinations when there is limited supplies available and all healthcare workers may not be able to receive vaccinations. Determined that the SP is focused on documentation of healthcare workers receiving vaccinations or not. If supplies are limited and no vaccinations are available….documentation needs to reflect circumstances. SP applicable.